New Procedure Helps Some Patients Avoid Coronary Bypass Surgery

Virginia Mason’s cardiovascular intervention team treats hundreds of blocked coronary arteries every year, all by way of small incisions and specially equipped catheters in a procedure known as percutaneous coronary intervention (PCI). Recently, cardiologists Gordon Kritzer, MD, and Wayne Hwang, MD, performed successful PCIs on patients who might otherwise have required major surgery to bypass their severely blocked arteries. 

The patients suffered from chronic total occlusion (CTO), a complete, longtime blockage of a coronary artery with debilitating symptoms including frequent chest pain. In the past CTO has proved challenging to treat with PCI, as total blockages are frequently impervious to the usual catheter-based tools. Now with more advanced operative tools and improved techniques, success rates of treating CTO with this minimally invasive technique have increased dramatically.

“This is an exciting technique we can use to treat patients with severe symptoms and high-risk occlusions of their coronary arteries,” says Dr. Kritzer. “These new CTO techniques use a different approach, with new wires and tools, and special training for physicians and catheterization lab staff. With these improvements the success rates for opening totally occluded vessels has gone from below 50 percent to near 90 percent.” 

Because treating CTO in the catheterization lab requires an initial investment in both training and new equipment, not all medical centers choose to offer the advanced procedure. Dr. Hwang, director, Cardiac Catheterization Laboratory, notes that senior leadership at Virginia Mason was in favor of the practice from the beginning. 

“We knew bringing this cutting-edge capability to Virginia Mason was essential to keeping us at the forefront,” said Dr. Hwang. “These are the most demanding and challenging type of cases that we face.” 

Identifying appropriate patients remains a critical part of successfully treating CTO using catheterization. Drs. Kritzer and Hwang rely on a patient algorithm developed especially for determining good candidates for the procedure. With proper patient selection, complication rates of performing PCI for CTO patients are comparable to those of treating non-CTO cases, and many patients can be spared the trauma and risk of invasive coronary bypass surgery. 

“Our first patient who underwent CTO treatment in the catheterization lab was up and walking the halls the same day as her procedure,” says Michaelle Wetteland, RN, director, Acute Care Services. “She said she felt great.”

A version of this article was originally published on Virginia Mason’s internal news site.


  1. Audra Cummings Journalist, former publisher of Group Practice Journal,circa !980"s says:

    Kudos for your innovative, and consistent high quality of care.

  2. Yolanda says:

    My husband will be receiving PCI for his CTO tomorrow at Mass General Hospital. Feeling Very optimistic about this new procedure.

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